Cirrhosis

Cirrhosis:  This chronic disorder is marked by diffuse destruction and fibrotic regeneration of hepatic cells.  As necrotic tissue yields to fibrosis, cirrhosis alters liver structure and normal vasculature, impairs blood and lymph flow, and ultimately causes hepatic insufficiency.  It is twice as common in men as in women - particularly among malnourished chronic alcoholic patients over age 50.  Mortality is high; many patients die within 5 years of onset

Portal, nutritional or alcoholic cirrhosis also known as Laennec's cirrhosis, is the most common type, results from malnutrition, especially of dietary protein, and chronic alcohol ingestion. 

Biliary cirrhosis results from bile duct diseases.

Postnecrotic (posthepatitic) cirrhosis stems from various types of hepatitis

Pigment cirrhosis may stem from disorders such as hemochromatosis

In 10% of patients, cirrhosis has no known cause.

Symptoms:

Gastrointestinal - usually early and vague - Anorexia, indigestion, nausea and vomiting, constipation or diarrhea, dull abdominal ache

Respiratory:  Pleural effusion, limited thoracic expansion

Central nervous system:  progressive symptoms of hepatic encephalopathy, including lethargy, mental changes, slurred speech, asterixis (flapping tremor), peripheral neuritis, paranoia, hallucinations, extreme obtundation, and coma

Hematologic:  bleeding tendencies (nosebleeds, easy bruising, bleeding gums), anemia

Endocrine:  testicular atrophy, menstrual irregularities, gynecomastia, loss of chest and axillary hair

Skin:  severe pruritus, extreme dryness, poor tissue turgor, abnormal pigmentation, spider angiomas, palmar erythema, possibly jaundice

Hepatic:  jaundice, hepatomegaly, ascites, edema of the legs

Miscellaneous:  musty breath, enlarged superficial abdominal veins, muscle atrophy, pain in the right upper abdominal quadrant that worsens when the patient sits up or leans forward, palpable liver or spleen, temperature of 101 degree to 103 degree F, bleeding from esophageal varices.

Treatment:

Treatment aims to remove or alleviate the underlying cause of cirrhosis, to prevent further liver damage, and to prevent or treat complications.

High protein diet (but this may be restricted by developing hepatic encephalopathy.)

Sodium is usually restricted to 200mg to 500mg per day and fluids to 1,000 to 1,500 ml/day

Hospitalization:  if the patients condition continues to deteriorate, he may need tube feeding

Rest, moderate exercise, and avoiding exposure to infections and toxic agents are essential.

Paracentesis and infusion of salt poor albumin may alleviate ascites.  A LeVeen shunt may be used

Surgical procedures include ligation of varices, splenectomy, esophagogastric resection, and surgical shunts to relieve portal hypertension

Programs for preventing cirrhosis usually emphasize avoiding alcohol

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